NPIMap

Organization Active NPI

King David Aquatic Center LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Beachwood, OH
National Provider Identifier
1770351306
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
KING DAVID AQUATIC CENTER LLC
Practice address
27300 Cedar Rd
Beachwood, OH 44122-1110
Phone
(216) 831-6500
NPI assigned
Dec 13, 2023
Last updated
Dec 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Z Rosenberg
Title
Business Office
Phone
(732) 335-6951

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X NU Primary

Addresses

Primary practice location

27300 Cedar Rd
Beachwood, OH 44122-1110

Mailing address

27300 Cedar Rd
Beachwood, OH 44122-1110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240715004091 OH Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3870038714 Practice locations: Beachwood, OH
O20240807004621 OH Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 3870038714 Practice locations: Beachwood, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770351306. Details of each certification follow.

  • CCN 366741 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 366741

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
KING DAVID AQUATIC CENTER LLC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Jun 2, 2006
Last certification
Nov 22, 2017
Ownership / control type
Voluntary Non-Profit Other Than Church
Most recent change of ownership
Dec 19, 2023
Facility address
27300 Cedar Road
Beachwood, OH 44122

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1770351306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27300 CEDAR RD",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441221110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27300 CEDAR RD",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441221110",
            "telephone_number": "216-831-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING DAVID AQUATIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-13",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "ROSENBERG",
        "authorized_official_first_name": "Z",
        "authorized_official_title_or_position": "BUSINESS OFFICE",
        "authorized_official_telephone_number": "732-335-6951"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beachwood, OH

Sources for this page

Verify at the official NPI Registry.